RESECTION OF THE FIRST ROW OF THE CARPUS: RESULTS IN 44 CASES AT MORE THAN TEN YEARS

Abstract

Purpose: This retrospective analysis was performed to determine the long-term usefulness of carpectomy and to define prognostic factors.

Material and methods: Forty-four patients were operated. There mean age was 39.2 years, and mean follow-up was 17 years (10–35 years). Twenty-two patients had osteoarthritis, one STT, thirteen SNAC-wrist, two SLAC-wrist, and three radiocarpal osteoarthritis. The wrists were free of degenerative lesions in 22 cases: eight Kienböck disease, five longstanding perilunar dislocations, six fracture sequelae, and one rheumatoid polyarthritis. Seventeen patients had had several procedures before the present operation. The dorsal approach was used for all patients except five. Complementary styloidectomy was associated in two cases. clinical and radiological outcome was assessed at one, five and fifteen years. Factors predictie of outcome were analysed with the Student test and the Man and Whitney test.

Results: The pain score (Cooney scale 1 to 4) was 3.19 preoperatively and 1.56, 1.88 and < 2 at one, five and fifteen years respectively. Flexion amplitude improved from 44° preoperatively to 61°, 68° and 62° at one, five and fifteen years respectively. Mean grip force, compared with the other wrist was 57.5%, 75% and 64% at one, five and fifteen years. Radiographically, at fifteen years 80% of the patients had a centred capitatum on the AP view of the lunar facet. On the lateral view, 56% of the patients exhibited anterior translation of the apitatum and 37% were centred. There was a degradation of the radiocapitum space requiring revision for arthrodesis in five cases.

Discussion, conclusion: This study confirms the long-term preservation of outcome after proximal carpectomy: 89% of the patients were satisfied at fifteen years. These findings also indicate that reconstruction of recent trauma (fracture-dislocation) produces variable results. For patients with grade II or II osteoarthritis (SNAC or SLAC-wrist) carpectomy should be reserved for selected patients with occupational or sports activities not requiring grip force. For grade III wrists, carpectomy can be proposed for elderly patients with limited activity. Grade IV is a contraindication for carpectomy. We do not recommend this procedure for patients with rheumatoid arthritis or Kienböck disease.